High-Risk Family Risk Assessment - Term Paper Example

On any given day 800,000 people are homeless in the United s and homelessness is one such high risk family group amongst others (Moses, n.d Families with children are the fastest growing segment in the homeless population. Nearly one-quarter of the homeless population comprises of children. The reasons for homelessness could be with structural or individual. Structural reasons include social assurance in the form of social security or insurance or mental health support (Burt et al., n.d.). Due to the rising economy, increased rent has made accommodation out of reach of the poorest Americans. Currently thirty-one million people live in poverty in America and when unable to pay the rent, streets and homeless shelters are the only alternative. More than 30 percent of the income is required to be spent on house rent alone and almost 28 million people have to face this burden. Apart form this, people find health insurance beyond their means and one serious illness can wipe the family’s savings and income and make them homeless. Fire, flood or natural disaster can also render people homeless. Government and corporate policies are also responsible for leaving millions of hard-working people homeless (Ely-Chaitlin, n.d.). Millions lost their pension through legislative tricks or lost their life’s savings through Savings and Loan scandal. Overnight they became homeless. Homeless adults are twice as likely to have mental illness compared to general adults and twenty percent of the homeless adults have had previous psychiatric hospitalization (Gelberg & Linn, 1988). Studies revealed that they have the poorest perceived health status and those with previous psychiatric hospitalization may delay seeking outpatient medical care as they find barriers to such services. By the time they seek help they are so ill they have to be hospitalized. Mental illnesses that homeless people suffer from include psychosis and schizophrenia (Acorn 1993). They are also victims of alcohol, drug abuse and acute distress. Apart from mental disease they are also hospitalized for emotional and nervous problems. Survey of the users of the emergency shelters revealed that they had difficulty in breaking the cycle of poverty, unemployment and homelessness. Fifty per cent of the respondents have not even completed high school which adds to the difficulty of finding a job. Dental care is very commonly required but a large number of respondents reported that they were able to follow the prescribed medication for their treatment. Acorn states that an emergency shelter is not the appropriate residence for persons with mental illness. Sexual violence is a major problem concerning homeless women. Studies revealed high prevalence of health and substance abuse in those who had been raped (Wenzel, Leake & Gelberg, 2000). Women who reported rape during the previous year also had symptoms of gynecological problems and serious physical health symptoms. Distress and depression was common among those raped and they were reluctant to get treatment. Homeless men, women and children are vulnerable to diseases, progressive morbidity and premature death (Plumb, 1997). Homelessness and poverty are interlinked and those living in poverty have a high-risk of becoming homeless. Sub-groups of poverty like those mental disability or post-traumatic stress syndrome associated with war service, those addicted to drugs or alcohol, or those who lack social support or those who do not qualify for welfare. With continuing unemployment and deepening of the erosion, the homelessness is increasing every year. Added to this is the disappearance of the federal-government’s affordable-housing initiatives and the socio-economic polarization. The basic goals of Healthy People 2010 are to increase the quality and years of healthy life and eliminate ethnic/racial and socio-economic health disparities. One of the health problem common to the homeless is the mental diseases like psychosis and schizophrenia. Objective 18-3 aims to reduce the proportion of homeless adults who have serious mental illness (SMI). In 1996 25 percent of homeless adults aged 18 years or older had SMI. Healthy People 2010 have set a target to bring about 24 percent improvements in this sector. This requires suitable nursing intervention strategies. Nursing intervention requires an assertive approach and a caring relationship with homeless SMI patients. The six primary functions, according to Willenbring et al., (cited by Morse, n.d.), as a case manager would require the nurse to determine the client’s current and potential strengths and weaknesses, develop a specific, comprehensive, individualized treatment and service plan. If the situation so demands, the nurse may also have to refer or transfer clients to necessary services and treatments for informal support systems. This role also demands ongoing evaluation of the needs and progress of the client and may require the nurse to intercede on behalf of the client to ensure appropriate services. Since SMI is a critical disorder, the nurses’ role as a case manager may call for additional services which include assisting clients in crisis to stabilize through direct interventions, creating additional resources to enhance the treatment. The nurse would have to determine the duration, intensity and focus of services, and be responsible for the resources. While different approaches have been suggested, Intensive case management (ICM) approach has been extensively used in homeless SMI patients. This is because it adheres to the clinical principles – it has an assertive and persistent outreach, reduces case loads, and provides active assistance in accessing needed resources. Another program called the Assertive community treatment (ACT) for the homeless with SMI places emphasis on clients’ resource and housing needs. According to Johnsen, Samberg, Calsyn, Blasinsky, Landow, & Goldman (1998 cited by Morse), ACT has been widely promoted and replicated through the CMHS ACCESS program. The Strengths Model had been used of non-homeless SMI patients but recently study suggests that it has been used for homeless clients in Kansas under the ACCESS grant (Johnsen et al., 1988 cited by Morse). Another tested approach for the homeless SMI is the Critical time intervention (CTI) which aims to strengthen the individuals long-term ties to services, family, and friends (Herman, Felix, Susser & Barrow 2006). The mentally ill individuals and those on whom they depend need assistance to work with one another. This case management approach also provides emotional and mental support during the critical time of transition. CTI has been tested in an NIMH-funded RCT and the result was significant, lasting reduction in post discharge homelessness among men with SMI. Across different studies positive outcomes have been reported from the ACT and CTI approaches. ACT led to improved service utilization, treatment retention and reduced psychiatric symptoms in addition to vocational functioning and social adjustment (Morse). Nevertheless research suggests that case management services are less effective with clients which include men, people with more psychotic symptoms, those with longer homelessness histories and people with co-occurring substance abuse disorders. The role of an advance nurse as a case manager must have the necessary knowledge, skills and abilities to work with the homeless SMI clients. This requires a thorough knowledge of homelessness and they should be able to engage the homeless clients with severe mental illness. This implies that the nurse should be able to develop a trusting and caring relationship with the clients, respond timely to the need depending upon priority, be dependable but flexible, and be alert to the often changing needs of the clients and the services required. They should also be aware of the local services and resources. Dealing with SMI requires specialized training even for the nurses. They should also be prepared to prevent burnout during the intervention. Mental health consumer preference surveys suggest that homeless persons with SMI should live independently, typically in a solitary household (O’Flaherty, Ellen, Rosenheck & Barrow, 2006) but single person households are atypical in US society. US already has shortage of affordable housing units and hence this suggestion may not be the most effective use of available housing resources. No research as yet is available on the positive outcome of such housing models. Among the homeless young adults, behavioral barriers impede them from making optimal use of shelter and housing opportunities. Thus further intervention has to be developed to ameliorate these barriers. Rosner, Barrow, Sclar and Schretzman (2006) explain that an understanding of the broad context within which the homelessness and the interventions occur is essential. Interventions and approaches may differ depending upon the characteristics of local homeless populations and the nature of the social exclusion that homeless persons experience. These might also set the conditions within which the approaches to homelessness have evolved. Decisions may also be influenced by local policies. Hence a central concern in necessary to provide mental health services to the homeless with SMI. Only then can effective intervention reach those in need. The period of homelessness and the SMI may vary across individuals. Some may be homeless for a small period in their lives while others may have recurrence. Even the psychiatric disorders may keep changing. Such patterns not only affect the affected person’s quality of life but the interventions and service may have to be altered. Hence the case manager has to consider all of these before applying the approach most relevant. References: Acorn S., (1993), Mental and Physical Health of Homeless Persons Who Use Emergency Shelters in Vancouver, Hospital and Community Psychiatry, Vol 44 No. 9 pp. 854-857 Burt et al., Helping Americas Homeless, Chapter 1, 12 Feb 2007 Ely-Chaitlin M E (n.d.), How the City of Dana Point Spent Your Money Shutting Down A Homeless Shelter, 12 Feb 2007 Gelberg, L., & Linn, K. S., (1988), Social and Physical Health of Homeless Aduks Previously Treated for Mental Health Problems, Hospital and Community Psychiatry, Vol 39 No. 5 pp. 510-516 Herman, D., Felix, A., Susser, E., & Barrow, S., (2006), Research Summary by CCHPS, 12 Feb 2007 Morse, G., (n.d.), A Review of Case Management for People Who Are Homeless: Implications for Practice, Policy, and Research, 12 Feb 2007 Moses D J (n.d.), Americas Homeless Children, 12 Feb 2007 O’Flaherty, B., Ellen, I.G., Rosenheck, R., & Barrow, S., (2006), Research Summary by CCHPS, 12 Feb 2007 Plumb, J. D., (1997), Homelessness: Care, Prevention, and Public Policy, 12 Feb 2007 Rosner, D., Barrow, S., Sclar, E., & Schretzman, M., (2006), Research Summary by CCHPS, 12 Feb 2007 Wenzel, S. L., Leake, B. D., & Gelberg, L., (2000), Health of Homeless Women with recent experience of rape, J Gen Intern Med 2000: 15,: 265-268 Read More